For over a century, melancholia has been linked to increased rates of morbidity and mortality. Data from two epidemiologically complete cohorts of patients presenting to mental health services in North Wales (1874–1924 and 1995–2005) have been used to look at links between diagnoses of melancholia in the first period and severe hospitalized depressive disorders today and other illnesses, and to calculate mortality rates. This is a study of the hospitalized illness rather than the natural illness, and the relationship between illness and hospitalization remains poorly understood. These data confirm that melancholia is associated with a substantial increase in the standardized mortality rate both formerly and today, stemming from a higher rate of deaths from tuberculosis in the historical sample and from suicide in the contemporary sample. The data do not link melancholia to cancer or cardiac disease. The comparison between outcomes for melancholia historically and severe mood disorder today argue favourably for the effectiveness of asylum care.

Ergotism in Norway. Part 1: The symptoms and their interpretation from the late Iron Age to the seventeenth century (Torbjørn Alm and Brita Elvevåg)

Ergotism is a horrendous disease with grotesque symptoms caused by ingesting specific ergot alkaloids. Mass poisoning episodes are attributable to consumption of grain – usually rye – infected with the fungus Claviceps purpurea. By focusing on possible cases of ergotism, we re-examine Norwegian history from the sagas through to the end of the seventeenth century. Our review – not intended to be exhaustive, orex post facto to assign medical or psychiatric labels – draws attention to the very real possibility that many remarkable medical cases may have been the result of the ingestion of highly poisonous and psychoactive food substances. Where possible we highlight explanations given at the time – often rooted in religion or demonology – to explain the disease.

Revisiting mental hygiene: Josef Lundahl’s interpretation of modern psychiatry in Sweden at the beginning of the twentieth century (Katarina Piuva)

The concept of mental hygiene is historically intertwined with eugenics and what it meant both ideologically and for the care of the mentally ill. A closer investigation of the concept and of the historical context shows that different interpretations existed simultaneously. The aim of this essay is to highlight the literary and scientific works of a Swedish psychiatrist, Josef Lundahl, an advocate of the mental hygiene concept. A close reading of his texts is used to provide an example of how the concept of mental hygiene was understood by a psychiatrist and practitioner of mental hygiene. The practice of child-care and out-patient care that Lundahl founded in Visby is far from what we now associate with mental hygiene in the past.

This text develops three interwoven issues: first, a succinct comparative analysis of medical and psychiatric semiology, which proposes that the lack of referring relations between psychiatric symptoms and brain/psychic dysfunction is a fundamental distinction between medical and psychiatric semiology. Second, the multiple features of psychiatric semiology are reviewed. Third, a new approach to psychopathology is introduced, proposing three different ways to shape symptoms (perception, linguistic structure, praxis); highlighting its role as a cognitive activity that creates intelligibility from undifferentiated experiences; and distinguishing psychopathology and semiology on an activity/product relation basis.

William James and psychical research: towards a radical science of mind (Alexandre Sech Junior, Saulo de Freitas Araujo, and Alexander Moreira-Almeida)

Traditional textbooks on the history of psychiatry and psychology fail to recognize William James’s investigations on psychic phenomena as a legitimate effort to understand the human mind. The purpose of this paper is to offer evidence of his views regarding the exploration of those phenomena as well as the radical, yet alternative, solutions that James advanced to overcome theoretical and methodological hindrances. Through an analysis of his writings, it is argued that his psychological and philosophical works converge in psychical research revealing the outline of a science of mind capable of encompassing psychic phenomena as part of human experience and, therefore, subject to scientific scrutiny.

‘Paralysed with fears and worries’: neurasthenia as a gender-specific disease of civilization (Jessica Slijkhuis and Harry Oosterhuis)

Around 1900 neurasthenia received much attention in both the medical world and society at large. Based on professional publications by Dutch psychiatrists and neurologists and on patient records from the Rhijngeest sanatorium near Leiden in the Netherlands, this article addresses the meanings and interpretations of this nervous disorder as put forward by doctors and patients. We argue that their understanding of this disorder was determined not only by medical views, but also by social-cultural factors and prevailing gender norms.

Use and abuse of alcohol and other drugs during the heroic age of Antarctic exploration (HR Guly)

During the heroic age of Antarctic exploration, there was much discussion on the role of alcohol. The explorers expected to be able to consume alcohol, and the expeditions were supported by companies producing alcoholic beverages that used the Antarctic connection in their advertising. On the other side, it was said (incorrectly) than Fridjof Nansen, perhaps the most famous of the Arctic explorers, had taken no alcohol and this was used in the arguments against alcohol by the temperance movement. In general, alcohol consumption was low but it was felt that alcohol played an important role in maintaining the psychological welfare of the participants. A number of them had alcohol problems, and participation in an expedition was thought to be of benefit in that it would remove the temptation to consume alcohol. However, there were episodes of drunkenness on the ships and in the Antarctic. Cocaine was taken as one of a number of tonics but only one explorer is thought to have abused drugs, though another is said to have done so.

The issue also contains a number of book reviews and the classic text ‘On the Diseases of the Head’ in the Scale of Medicine by Muhammad Akbar Arzn [d. 1722] (presented by Neil Krishan Aggarwal)